Hoarseness due to aortic arch aneurysms

Abstract Objective: To give an overview of the Ortner's syndrome caused by an aortic arch aneurysm. Methods: By comprehensive retrieval of the pertinent literature published in the past two decades, 75 reports including 86 patients were collected and recruited into this study along with a recent case of our own. Results: The aortic arch aneurysms causing hoarseness were most commonly mycotic aneurysms. In this patient setting, in addition to the left recurrent laryngeal nerve, trachea was the most commonly affected structure by the aortic arch aneurysm. Surgical/interventional/hybrid treatments led to a hoarseness-relieving rate of 64.3%, much higher than that of patients receiving conservative treatment. However, hoarseness recovery took longer time in the surgically treated patients than in the interventionally treated patients. Conclusion: The surgical and interventional treatments offered similar hoarseness-relieving effects. Surgical or interventional treatment is warranted in such patients for both treatment of arch aneurysms and relief of hoarseness.

A Case of Behçet's Disease Mimicking Vertebral Invasion of a Mycotic Aneurysm / 대한내과학회지

Behçet's disease is a systemic vasculitis of unknown etiology characterized by recurrent oral and genital ulcers and uveitis. The vascular involvement of Behçet's disease affects arteries, veins, and blood vessels of all sizes, and it can include venous or arterial thrombosis and arterial aneurysms. There are only a few reports of an aortic aneurysm invading a vertebral body in a patient with Behçet's disease. Here, we report the case of a 45-year-old man who was initially diagnosed with vertebral invasion of a mycotic aneurysm. He underwent vascular surgery and received empirical antibiotics, but all cultures were negative. However, he had persistent, recurrent deep vein thrombosis and elevated inflammatory markers. After reviewing the pathology, a final diagnosis of Behçet's disease was made. He was successfully treated with corticosteroids. This report presents a rare case of Behçet's disease mimicking vertebral invasion of a mycotic aneurysm.

Mycotic aneurysm with aortoduodenal fistula

Firstly described in the 19th century by Sir William Osler, the mycotic aneurysm (MA) is a rare entity characterized by an abnormal arterial dilation, which is potentially fatal, and is associated with the infection of the vascular wall. Elderly patients are mostly involved, especially when risk factors like chronic diseases, immunosuppression, neoplasia, and arterial manipulation are associated. The authors report the case of a young male patient diagnosed with an aortic aneurysm of infectious origin in the presence of repeated negative blood cultures. The diagnostic hypothesis was raised when the patient was hospitalized for an inguinal hernia surgery. The diagnosis was confirmed based on imaging findings consistent with mycotic aneurism. The patient was treated with an endovascular prosthesis associated with a long-lasting antibiotic therapy. Five months later, the patient attended the emergency unit presenting an upper digestive hemorrhage and shock, from which he died. The autopsy revealed a huge aneurysm of the abdominal aorta with an aortoduodenal fistula. The histological examination of the arterial wall revealed a marked inflammatory process, extensive destruction of the arterial wall, and the presence of Gram-positive bacteria. This case highlights the atypical presentation of a MA associated with an aortoduodenal fistula. Besides the early age of the patient, no primary arterial disease could be found,and no source of infection was detected.

Infectious Pseudoaneurysm Caused by Group A Streptococcus in a Child without Underlying Disease

Group A streptococcus is a common cause of upper respiratory infection in children; however, it is a rare cause of pseudoaneurysm in pediatrics with only limited reports of cases associated with cardiac surgery and underlying disease. We report a case of infectious pseudoaneurysm of the right internal iliac artery caused by group A streptococcus in a previously healthy 5-year-old boy who presented with scarlet fever and group A streptococcal bacteremia. He was admitted to the hospital with fever, rash on the whole body, and sore throat, accompanied by severe leg pain. He was treated with surgical removal and antibiotics. Because a pseudoaneurysm may develop in children without vascularrelated underlying diseases, we should consider the possibility of this important clinical diagnosis in patients with scarlet fever.

Infectious Pseudoaneurysm Caused by Group A Streptococcus in a Child without Underlying Disease

Group A streptococcus is a common cause of upper respiratory infection in children; however, it is a rare cause of pseudoaneurysm in pediatrics with only limited reports of cases associated with cardiac surgery and underlying disease. We report a case of infectious pseudoaneurysm of the right internal iliac artery caused by group A streptococcus in a previously healthy 5-year-old boy who presented with scarlet fever and group A streptococcal bacteremia. He was admitted to the hospital with fever, rash on the whole body, and sore throat, accompanied by severe leg pain. He was treated with surgical removal and antibiotics. Because a pseudoaneurysm may develop in children without vascularrelated underlying diseases, we should consider the possibility of this important clinical diagnosis in patients with scarlet fever.

Clinical analysis of infective endocarditis complicated with intracranial hemorrhage / 中华全科医师杂志

Objective To analyze the clinical characteristics of infective endoearditis complicated with intracranial hemorrhage.Methods The clinical characteristics,brain CT and MRI results and prognosis of 7 patients with infective endocarditis and intracranial hemorrhage admitted between January 1991 and May 2015 were retrospectively analyzed.Results All seven patients presented varying degrees of fever,cardiac murmur and neurological symptoms.The continuous fever lasted from 21 d to 227 d (average 91 d).Mitral valve (4 cases) and aortic valve (3 cases) were the most common affected ones.The brain CT or MRI scan presented intracranial hemorrhage in 6 cases.More than 2 hemorrhage locations were found in 5 patients and parietal lobe was most common one (4 cases).All patients were treated with antimicrobial agents and three patients underwent valve replacement surgery.Three patients were cured and another 2 died due to fatal hemorrhage.Conclusions Patients with long fever history and ineffective antimicrobial treatment are prone to intracranial hemorrhage.Brain CT or MRI scan need be performed in infective endocardits when neurological symptoms are present,and brain angiography should be also considered if necessary.

Mycotic Abdominal Pseudoaneurysm due to Psoas Abscess after Spinal Fusion

A 36-year-old man, who had undergone thoracoscopic anterior spinal fusion using the plate system and posterior screw fusion three months previously, presented to our hospital with left flank pain and fever. Computed tomography indicated the presence of a psoas muscle abscess. However, after two days of percutaneous catheter drainage, a mycotic abdominal aortic pseudoaneurysm was detected via computed tomography. We performed in situ revascularization using a prosthetic graft with omental wrapping. Methicillin-resistant Staphylococcus aureus was identified on blood and pus culture, and systemic vancomycin was administered for one month. Although the abscess recurred, it was successfully treated with percutaneous catheter drainage and systemic vancomycin administration for three months, without the need for instrumentation removal. The patient remained asymptomatic throughout two years of follow-up.

Infected Aneurysm of the Abdominal Aorta due to Streptococcus pneumoniae / 대한내과학회지

Streptococcus pneumoniae (S. pneumoniae), a bacterium that is part of the normal flora of the upper respiratory tract, can cause pneumonia, bacteremia, otitis media, and meningitis. There are few reports of infected abdominal aortic aneurysms due to S. pneumoniae, especially in Korea. We here present a 53-year-old male with an infected abdominal aortic aneurysm caused by S. pneumoniae. This patient had no previous history of atherosclerosis or infection of other organs such as the lungs, heart, or bones. He underwent resection of the abdominal aorta and iliac artery as well as bypass surgery, with maintenance of peri-operative intravenous antibiotics for 6 weeks. He has shown favorable outcomes after a 3-month follow-up.

A Case of an Infected Aneurysm in the Thoracic Aorta Mimicking Tuberculous Lymphadenopathy / 대한내과학회지

Tuberculous-infected aortic aneurysms are rare, but delayed diagnosis can lead to serious complications, including sudden aortic rupture. Here, we report a case of a tuberculous infected aneurysm in the thoracic aorta that was mistaken for lymphadenopathy. In this case, we could differentiate the lesion with the aid of contrast-enhanced computed tomography and positron emission tomography (PET). This case demonstrates the diagnostic value of PET in aortic aneurysms.

Infected Aortic Aneurysm caused by Mycobacterium bovis after Intravesical Bacillus Calmette-Guerin Treatment for Bladder Cancer / 감염과화학요법

A 70-year-old man presented with lower back pain and cyanotic changes in his left lower extremity. He was diagnosed with infected aortic aneurysm and infectious spondylitis. He had received intravesical Bacillus Calmette-Guerin (BCG) therapy up to 1 month before the onset of symptoms. The aneurysm was excised and an aorto-biiliac interposition graft was performed. Mycobacterium tuberculosis complex was cultured in the surgical specimens. Real-time polymerase chain reaction (PCR) targeting the senX3-regX3 region, and multiplex PCR using dual-priming oligonucleotide primers targeting the RD1 gene, revealed that the organism isolated was Mycobacterium bovis BCG. The patient took anti-tuberculosis medication for 1 year, and there was no evidence of recurrence at 18 months follow-up.

Aneurisma coronariano micótico: relato de dois casos / Mycotic coronary aneurysm: report of two cases / Aneurisma coronario micotico: reporte de dos casos

O número de intervenções percutâneas com implante de stents tem aumentado dramaticamente nos últimos anos, apesar da frequência no uso do dispositivo nos relatos de infecções serem extremamente raros. Neste artigo relatamos dois casos de aneurisma micótico após implante de stents com diferentes apresentações clínicas e evolução.

The number of percutaneous interventions with stent implantation has increased dramatically in recent years, although the frequent use of this device in reports of infections is extremely rare. In this article we report two cases of mycotic aneurysm after implantation of stents with different clinical presentations and outcomes.

El número de intervenciones percutáneas con implantación de stents ha incrementado dramáticamente en los últimos años, a pesar del gran auge del dispositivo los reportes de infecciones son extremadamente raros. En el presente artículo reportamos dos casos de aneurismas micoticos luego de la implantación de stents con presentación y evolución clínicas diferentes.

Aneurismas infecciosos: incidência, diagnóstico e tratamento / The infectious aneurysms: incidence, diagnosis and treatment

O objetivo deste trabalho é apresentar a revisão de literatura acerca dos novos parâmetros de incidência, diagnósticos e terapêuticos, dos aneurismas infecciosos. Foi realizada pesquisa no banco de dados Bireme e PubMed,com os termos: ?aneurysm?, ?mycotic? e ?infectious?, sendo usados para o estudo apenas artigos publicados entre 1997 e 2010. Grande parte dos artigos descreve uma alta incidência de múltiplos aneurismas e a localização preferencialmente proximal, quando associados à endocardite infecciosa, e distal, quando associados a outras infecções, também relatando a alta eficiência do tratamento endovascular, contudo uma alta mortalidade quando este é inviável. Novas técnicas diagnósticas são propostas e merecem mais estudos. A taxa de incidência e a alta taxa de mortalidade associada a casos em que a intervenção endovascular é inviável justificam exames direcionados ao diagnóstico precoce desses aneurismas em pacientes potenciais.

The objective of this paper is to present a literature review of incidence, diagnosis and treatment of infectious aneurysms. A search was carried out at the Bireme database and PubMed by the terms: ?aneurysm?, ?mycotic? and ?infectious?, being used to study only articles published between 1997 and 2010. Most of the articles describe a high incidence of multiple aneurysms, and proximal location when associated with infective endocarditis and distal when associated with other infections. It is reported a high efficiency in endovascular treatment, but a high mortality when unviable. New diagnostic techniques are proposed and deserve further study. The incidence and high mortality rate associated with cases in which endovascular intervention is not feasible, justify early diagnosis of these aneurysms in potential patients.

Aneurisma infectado de artéria braquial após endocardite infecciosa de valva mitral / Infected aneurysm of brachial artery after mitral valve infective endocarditis

Apresentamos um caso de aneurisma infectado de artéria braquial em paciente com endocardite infecciosa por Streptococcus bovis. Homem de 49 anos de idade se apresentou com febre, dispnéia e sopro regurgitativo em foco mitral com irradiação para axila. O ecocardiograma demonstrou vegetação em valva mitral nativa. Após troca valvar mitral com implante de prótese biológica, observou-se massa pulsátil de cinco centímetros de diâmetro em fossa antecubital direita. Foi feito o diagnóstico de aneurisma infectado de artéria braquial, e o tratamento cirúrgico foi realizado com sucesso. O objetivo desse relato de caso é apresentar uma complicação pouco comum após endocardite infecciosa.

We present a case of brachial artery infected aneurysm in a patient with infective endocarditis caused by Streptococcus bovis. A 49-year-old man presented with fever dyspnea and a pansystolic murmur with irradiation to axilla. The echocardiogram revealed vegetation in native mitral valve. After mitral valve replacement with bioprosthesis, it was observed pulsatile mass of five centimeters in diameter at antecubital fossa of right upper limb. It was made the diagnosis of infected aneurysm of the brachial artery, and the surgery was performed successfully. The aim of this case report is to show a rare complication after infective endocarditis.

Aorto-esophageal Fistula That Developed after Endovascular Stent-grafting of a Mycotic Aneurysm: A case report / 대한흉부외과학회지

A 74-year-old woman presented at our hospital with hemoptysis. Three months ago, she had endovascular stent-grafting done by a general surgeon for a saccular thoracic aneurysm that was found accidentally following an episode of fever and chills. Despite a lasting fever after the procedure, she was discharged without further treatment and follow-up. She was subsequently admitted to the hospital for evaluation and several exams were performed. Chest CT scans and an esophagoscopy identified an aorto-esophageal fistula at the level of the aorta that was covered by a previous stent-graft. After extensive administration of antibiotics, surgery was done - esophagectomy, cervical esophago-gastrostomy and replacement of the thoracic aorta. She was later discharged uneventfully.

Double Bypass of Esophagus and Descending Thoracic Aorta for the Treatment of Esophagopleural and Aortopleural Fistula / 대한흉부외과학회지

We report here on a case of double bypass of the esophagus and descending thoracic aorta for the treatment of esophagopleural fistula and aortopleural fistula due to an infected aortic aneurysm after esophageal rupture. A 48 year old man was diagnosed as having esophageal rupture after an accidental explosion. Although he had been treated by esophageal repair and drainage at another hospital, the esophageal leakage could not be controlled and subsequent empyema developed in the left pleura. Further, bleeding from the descending thoracic aorta had developed and he was managed with endovascular stent insertion to the descending thoracic aorta. He was transferred to our hospital for corrective surgery. We performed esophago - gastrostomy via the substernal route, without exploring posterior mediastinum and we let the empyema resolve spontaneously. While he was being managed postoperatively without any signs and symptoms of infection, sudden bleeding developed from the left pleural cavity. After evaluation for the bleeding focus, we discovered an infected aortic aneurysm and an aortopleural fistula at the stent insertion site. We performed a second bypass procedure for the infected descending thoracic aorta from the ascending aorta to the descending abdominal aorta via the right pleural cavity. We found leakage at the distal ligation site during the immediate postoperative period, and we occluded the leakage using a vascular plug. He discharged without complications and he is currently doing well without any more bleeding or other complications.

Obturator Bypass Surgery in a Patient with an Infected Femoral Artery Pseudoaneurysm with Sepsis / 대한흉부외과학회지

Infection of the both native and prosthetic vessels in the groin is a very serious disease because of recurrent arterial rupture and sepsis, and both these complications can cause death. The successful treatment of groin infection, including infection of the femoral artery, requires extensive excision of the infected tissues and restoration of the circulation. We experienced a case of obturator bypass in a patient with an infected femoral artery pseudoaneurysm and accompanying sepsis, and this occurred after performing a transfemoral angiogram in an A-V fistula of the carotid artery, and the patient also displayed intracranial hemorrhage.

A case of infected abdominal aortic aneurysm associated with liver abscess treated by endovascular stent / 대한내과학회지

A 72-year-old diabetic male patient with high grade fever, right upper quadrant abdominal pain and Klebsiella pneumoniae septicemia is reported. He suffered from high fever and abdominal pain in spite of aspiration of liver abscess and antibiotic treatment. A few days later, we found a palpable pulsating abdominal mass on physical examination. Computed tomography and angiography revealed infected abdominal aortic aneurysm associated with pyogenic liver abscess. He was treated by antibiotics and Endovascular stent without surgical resection. He improved without complications and has been followed-up after discharge with excellent condition. To our knowledge, this is the first case of infected abdominal aortic aneurysm as a septic metastatic lesion secondary to liver abscess.

Femoral artery ligation in treatment of infected femoral artery pseudoaneurysm caused by addictive drugs injection / 中国普通外科杂志

Objective To summarize our experience in management of infected femoral artery pseudoaneurysm caused by addictive drugs injection.Methods Clinical data of 45 cases of infeted femoral artery pseudoaneursysm were reviewed retrospectively.When infected femoral artery pseudoaneurysm was diagnosed,the femoral artery or external iliac artery was ligated and the pseudoaneurysm was resected in all of cases.Anticoagulants and antibiotics were used after operation.Results Lower limbs were salvaged in 44 patients.The ambulation function of affected limb was fine in the short-term.One limb was amputated because of lower limb deep venous thrombosis and gangrene.Thirty-four patients(75.6%) were followed up for 3-12 months,the results were satisfactory.Conclusions Femoral artery or external iliac artery ligation is an effective procedure for management of infected femoral artery pseudoaneurysm.

Surgical treatment of the infected femoral pseudoaneurysm caused by injection of heroin / 中国普通外科杂志

Objective To investigate the surgical treatment of infected femoral pseudoaneurysm caused by injection of heroin. Method Retrospective analysis was made on the clinical data of 14 cases of infected ruptured femoral pseudoaneurysm caused by injection of heroin. Results All 14 cases underwent operation. The ruptured sizes of arteries were 0.5 cm-2.0 cm . All cases were treated by resection of the aneurysm and replacement of iliac-femoral artery with artificial graft. Blood supply and function were good in all limbs after operations. Aneurysm cavities and incision wounds were treated with debridement, drainage and anti-infective treatment. All wounds were healed. 2 weeks and 3 months after operation, the grafts were patency demonstrated by Color Doppler examination. None of them was complicated with anastomosis leakage or thrombosis. Conclusion Thorough debridement of aneurysms and reconstruction of the artery are the effective approach in treating the infected ruptured femoral pseudoaneurysm caused by injecting heroin. Sufficient drainage, anti-infective and anti-coagulation therapy should be considered after the operation.

Diagnosis and treatment of infected pseudoaneurysms resulted from drug injecti on / 中国普通外科杂志

Objective To study the diagnosis and treatment of infected pseudoaneurysms(PA) resulting from drug injection. MethodsThe clinical data of 11 cases of i nfected PA resulting from drug injection were reviewed retrospectively.1 pat ient was treated by non-operation,10 cases were treated by artificial blood ve ssel transplantation after removal of PA and local debridement. Results One case dead. All the 10 cases treated by operation had satisfactory results and none had ischemic symptom of the limbs.Eight grafts were patent d emonstrated by color Dopler ultrasonography 3 months postoperatively. Conclusions The diagnosis of PA induced by drug injection can be m ade by the history of drug injection, pulsate mass of injection site. The eff ective treatment should include control of infection,local debridement,PA res ection and blood vessel implantation .